Robinson Renee F, Nahata Milap C, Sparks Elizabeth, Daniels Curt, Batisky Donald L, Hayes John R, Mahan John D
Children's Research Institute, 700 Children's Drive, Columbus, OH 43205, USA.
Pediatr Nephrol. 2005 Jan;20(1):64-8. doi: 10.1007/s00467-004-1667-x. Epub 2004 Oct 27.
There is ample evidence that the same pathophysiological processes that affect cardiovascular function in adults with end-stage renal disease (ESRD) also operate in children with ESRD. In adults undergoing hemodialysis (HD), a good correlation has been established between left ventricular mass (LVM) and aortic distensibility (AD) as markers of cardiovascular disease progression; however, this correlation has not been established in children. Therefore, in this retrospective study we investigated some aspects of cardiovascular damage (i.e., LVM, LVMI, and AD) in children with ESRD undergoing HD (n=9) or peritoneal dialysis (PD, n=9), and analyzed the relationship between AD, LVM, LVMI, pre-dialysis, post-dialysis blood pressure (BP), and demographic factors in children and adolescents with ESRD. Both LVM and AD were significantly greater in the dialysis population than in a control population derived from our institutional files (P=0.015, P=0.001). LVM and LVMI in children undergoing HD (92.9+/-83.7 g, 80.1+/-31.1 g/cm) were not statistically different from the values in children on PD (130.0+/-89.2 g, 89.6+/-35.9 g/cm), (P=0.3, P=0.5). AD in children on HD (2.2+/-0.55 cm2* dynes(-1*(10-6)) was significantly lower than in children on PD (2.7+/-0.54 cm2* dynes(-1*(10-6)), (P=0.01). The findings in this study confirm earlier studies that demonstrated that LVMI is greater in children on dialysis. This study also demonstrates that abnormal vascular stiffness, as defined by AD, is present in these children. The degree of vascular stiffness in children receiving HD is greater than in children receiving PD. However, further study is needed to address how control of BP, uremia, and other factors may affect these abnormalities in children with ESRD.
有充分证据表明，影响终末期肾病（ESRD）成人心血管功能的相同病理生理过程也在ESRD儿童中起作用。在接受血液透析（HD）的成人中，左心室质量（LVM）和主动脉扩张性（AD）作为心血管疾病进展的标志物之间已建立了良好的相关性；然而，这种相关性在儿童中尚未得到证实。因此，在这项回顾性研究中，我们调查了接受HD（n = 9）或腹膜透析（PD，n = 9）的ESRD儿童心血管损伤的一些方面（即LVM、左心室质量指数[LVMI]和AD），并分析了ESRD儿童和青少年中AD、LVM、LVMI、透析前、透析后血压（BP）以及人口统计学因素之间的关系。透析人群的LVM和AD均显著高于来自我们机构档案的对照人群（P = 0.015，P = 0.001）。接受HD的儿童的LVM和LVMI（92.9±83.7 g，80.1±31.1 g/cm）与接受PD的儿童的值（130.0±89.2 g，89.6±35.9 g/cm）在统计学上无差异，（P = 0.3，P = 0.5）。接受HD的儿童的AD（2.2±0.55 cm2·dynes-1·(10-6)）显著低于接受PD的儿童（2.7±0.54 cm2·dynes-1·(10-6)），（P = 0.01）。本研究结果证实了早期研究，即透析儿童的LVMI更高。本研究还表明，这些儿童存在由AD定义的异常血管僵硬度。接受HD的儿童的血管僵硬度程度高于接受PD的儿童。然而，需要进一步研究以探讨血压控制、尿毒症和其他因素如何影响ESRD儿童的这些异常情况。
